Care of the Older Person LECTURE

The Older Person FOUR OLDER AGE GROUPS

GERONTOLOGY young old (65-74)
study of the aging process middle old (75-84)
Geriatrics old old (85-99)
care of aging people centenarians (>100) (RA 11982)
medical specialty dedicated exclusively to
providing high-quality, patient-centered care DEMOGRAPHICS OF AGING
for older adults 2018
Aging is Normal 8,013,059 Filipinos over 60 years old (8.2%)
normal changes occur in body structure and - 5,082,049 will be 65 years old and older
function PROJECTIONS
psychological and social changes also Philippines will enjoy the benefits of a
occur young population until 2030
GROWTH:
The Older Person 4.9% (2020)
someone over the age of 60 is considered an 5.6% (2025)
older person 6.3% (2030)
before people live longer than ever today INCREASED LIFE EXPECTANCY
RETIREMENT average age: 68.5 (2017) to 74 (2018)
reward for lifetime of working
not all people are lucky enough to have the PSYCHOLOGICAL CHANGES IN AGING
money or health to enjoy it cognitive and mental health like short term
CHRONIC ILLNESS IS COMMON in older memory in cognition like slower reaction times
person and reduced problem solving abilities
DISABILITY often results one in four older adults experiences a mental
many have at least ONE disability health problem such as DEPRESSION,
ANXIETY, SCHIZOPRENIA, or DEMENTIA
AGING
associated with being “OLD” or reaching
“OLDER ADULTHOOD”
most widely held view as just a PART of the
LIFE CYCLE
PROGRESSIVE PHYSIOLOGICAL CYCLE
LEADING TO SENESCENCE, or a decline of
biological functions and of the bodies ability to
adapt to metabolic stress
AGEISM
a personal revulsion and distaste for
growing old, disease, disability; and
fear of powerlessness,
“uselessness”, and death SOCIAL CHANGES
SENESCENCE decreased social contact with friends and family-
progressive deterioration of body person may withdraw
systems that can increase risk of reconciliation with past-resolving conflicts,
mortality losses, acceptance
a process by which a cell ages and changes in physical appearance maybe difficult
permanently stops dividing but changes in roles/tasks that people can manage
does not die and can make them feel they have less to
contribute
 Care of the Older Person LECTURE

WHAT INFLUENCES HEALTH IN OLDER AGE INTEGUMENTARY SYSTEM

Individual the skin losses it’s elasticity, strength, and fatty
behaviors tissue layer
age-related changes secretions from oil and sweat glands decrease-
genetics don’t need baths as often
disease blood vessels are fragile-bruise easily
environment they live in brown spots appear on sun-exposed areas
housing loss of skin’s fatty tissue layer affects body
assistive technologies temperature-tend to be cold
transport dry skin causes itching and skin is easily
social facilities damaged (use mild soap and apply lotion)
nails become thick and tough
PSYCHOLOGICAL-SOCIAL CHANGES feet usually have poor circulation
physical reminders of growing old can threaten the skin has fewer nerve endings-less able to fell
self-esteem and independence pain
social roles change-some are now being cared white or gray hair is common
for by their children hair loss occurs in men
how people cope with aging depends on: hair thins on men and women
HEALTH STATUS facial hair may occur in women
LIFE EXPERIENCES hair is drier from decreases in scalp oils
FINANCES skin disorders increase with age
EDUCATION
SOCIAL SUPPORT SYSTEM MUSCULOSKELETAL SYSTEM
muscle cells decrease in number
HOUSING OPTIONS muscles atrophy (shrink) and decrease in
only 5% of the 65+ elderly live in nursing strength
homes bones lose minerals, especially calcium
live with family bones lose strength, become brittle and break
adult day-care centers during the day easily
nursing centers vertebrae shorten
assistive living residences joints become stiff and painful
continuing care retirement communities mobility decreases
(CCRC) activity, exercise and diet help to prevent bone
board and care homes loss and loss of muscle strength
congregate housing (senior citizen housing)
NERVOUS SYSTEM
PHYSICAL CHANGES nerve cells are lost
occur with aging nerve conduction and reflexes slow
happens to everyone blood flow to the brain is reduced
the rate and degree of change vary with each changes occur in brain cells
person sleep patterns change
they depend on diet, health, exercise, stress, touch and sensitivity to pain and pressure are
environment, heredity, and other factors reduced
quality of life does not have to decline taste and smell dull
 Care of the Older Person LECTURE

EYE CHANGES MALE REPRODUCTIVE SYSTEM

blue and green colors are difficult to see the hormone testosterone decreases slightly
eyelids thin and wrinkle it affects strength, sperm production, and
tear secretion is less reproductive tissues
the pupil becomes smaller and responds less to an erection takes longer
light the phase between erection and orgasm is
clear visions is reduced longer
the lens of the eye yellows orgasm is less forceful then when younger
older persons become more farsighted unable erection are lost quickly
to see close items
WOMEN REPRODUCTIVE SYSTEM
EAR CHANGES menopause occurs in women
changes occur in the ACOUSTIC NERVE the women can no longer have children
eardrums atrophy-high pitched sounds are hard female hormones (estrogen & progesterone)
to hear decreases
wax secretion decreases the uterus, vagina and genitalia atrophy
wax becomes harder and thicker vaginal walls thin and there is vaginal dryness
arousal takes longer
CIRCULATORY SYSTEM orgasm is less intense
the heart muscle weakens the pre-excitement state returns more quickly
arteries narrow and are less elastic
sometimes circulatory changes are present
rest is needed during the day
GERONTOLOGICAL
overexertion is avoided
NURSING
RESPIRATORY SYSTEM GERONTOLOGICAL NURSING
respiratory muscles weaken specialty of nursing pertaining to older adults
lung tissue becomes less elastic the history and development of gerontological
the person may lack strength to cough and nursing is rich in diversity and experiences
clear the airway secretions focus is on increasing life expectancy
increasing numbers of acute & chronic health
DIGESTIVE SYSTEM conditions
salivary glands produce less saliva. nurses provide disease prevention & health
DYSPHAGIA is a risk promotion
taste and smell dull promote positive aging
loss of teeth and ill-fitting dentures cause GERONTOLOGY
chewing problems multidisciplinary and is concerned with physical,
peristalsis decreases mental, and social aspects and implications of
fewer calories are needed aging.
GERIATRICS
URINARY SYSTEM is a medical specialty focused on care
kidney function decreases and treatment of older persons
kidney atrophy GERONTOLOGICAL NURSES
blood flow to the kidneys is reduced geriatric nurse
the ureters, bladder an urethra lose tone and care specifically for elderly patients; specializing
elasticity in this area often work in rehabilitation centers,
bladder size decreases hospice facilities, nursing homes, geriatrician’s
if men, the prostate gland enlarges office and patients’ homes for one-on-one care
urinary tract infection are risks
 Care of the Older Person LECTURE

ROLES OF THE GERONTOLOGICAL NURSE SCOPE AND STANDARDS OF

“Nurses have to have knowledge and skills to GERONTOLOGICAL NURSING PRACTICE
assist older adults in a broad range of nursing scope
care issues, from maintaining health and Assessment
preventing illnesses, to managing complex, Diagnosis
overlapping chronic conditions and progressive, Outcome Identification
protracted frailty in physical and mental Planning
functions Implementation
provider of care Evaluation
teacher standards
manager Quality of Care
advocate Performance Appraisals
research consumer Education
HISTORY OF GERONTOLOGICAL NURSING Ethics
The American Nursing Association (ANA) Collaboration
formed a specialized group for geriatric nurses Research
in the 1960s to recognize geriatric nursing. Research Utilization
the specialty of gerontological nursing emerged
beginning in the 1950s, with the publication of PRACTICE SETTINGS
the first gerontological nursing textbook. Acute Care Hospital
Establishment of NGNA & Scope and Long-Term Care
Standards of Gerontological Nursing assisted living
Practice (1980’s) intermediate care - services are provided to
Established Hartford Foundation Institute of patients, usually older people, after leaving
Geriatric Nursing at NYU Division of hospital
Nursing (1990’s) subacute or transitional care
The Gerontology Nurses Association of the skilled care
Philippines (GNAP) was officially launched on alzheimer’s care
August 28, 2008 at the Philippine General hospice
Hospital. We believe that older persons have Rehabilitation
special nursing needs and concerns. Community
PIONEERS IN GERONTOLOGICAL NURSING home health care
Florence Nightingale foster care or group homes
first geriatric nurse independent living
in the 19th century through her work caring adult day care
for elder helpers and maids (CARE OF
SICK GENTLEWOMEN) ,MORTALITY AND MORBIDITY IN OLDER
Doreen Norton (1922-2007) ADULTS
focused career on care of the ages Cardiovascular diseases, all forms 18.56%
described advantages of learning geriatric Pneumonia 6.21%
care in basic education Malignant neoplasms, all forms 5.11%
learning patience, tolerance, COPD 3.42%
understanding and basic terminal Tuberculosis, all forms 3.04%
stages of disease and importance of Diabetes Mellitus 2.47%
skilled nursing care GI ulcers & other GI diseases 1.42%
preparing for the future Nephritis, nephrotic syndrome, nephrosis 1.19%
recognizing the importance of skilled Accidents and injuries 0.98%
nursing care Chronic liver diseases & cirrhosis 0.55%
being aware of the need to undertake
research
 Care of the Older Person LECTURE

a. HUMAN NEEDS THEORY

THEORIES OF AGING five basic needs motivate human
behavior in a life-long process toward
need fulfillment; the needs are prioritized
SOCIOLOGICAL THEORIES
such that more basic needs take
expected progressions from midlife to older
precedence before the complex need
life based on social factors
b. THEORY OF INDIVIDUALISM
it focus on the roles and relationships within
personality consists of an ego and
which individual engage in later life
personal and collective unconsciousness
a. ACTIVITY THEORY
that views life from a personal or external
suggests that the aging process is
perspective. Older adults search for life
slowed or delayed, and quality of life is
meaning & adapt to functional & social
enhanced when the elderly remain
losses
socially active
c. LIFE COURSE (LIFE SPAN) PARADIGM
b. DISENGAGEMENT THEORY
blend key elements in psychological
it is natural to withdraw from society
theories (life stages, tasks, &
c. SUBCULTURE THEORY
personality development) with
as people age, they develop their own
sociological concepts (role behavior &
distinct subculture that is separate from
interrelationship between individual &
the dominant culture
society); goal achievement is
d. CONTINUITY THEORY
associated with life satisfaction
older adults will usually maintain the
d. SELECTIVE OPTIMIZATION AND
same activities, behaviors, personality
COMPENSATION THEORY
traits, and relationships
individual copes with the functional
e. AGE STRATIFICATION THEORY
losses of aging through activity/role
is a system of conferring power and
selection, optimization, & compensation;
respect onto certain age groups
Critical life points are morbidity,
f. PERSON-ENVIRONMENT FIT THEORY
mortality, & quality of life; Facilities
the interaction between the abilities of
successful aging
an older adults and the particular
environment in which they live that
BIOLOGICAL THEORIES
create the conditions for overall well-
aging follows a biological timetable and may
being
represent a continuation of the cycle that
g. GEROTRANSCEDENCE THEORY
regulates childhood growth (programmed); is the
psychosocial theory that proposes older
age-related changes of the cell’s ability to
adults experience a mindset shift in
transfer chemicals, heat and electrical processes
multiple dimensions (cosmic,
that impair it
coherence, solitude)

PSYCHOLOGICAL THEORIES
a set of statements that summarizes and
explains mental and behavioral patterns within
the context of society and culture: Explain aging
in terms of mental processes, emotions,
attitudes, motivations and personality
development that is characterized by life stage
transitions
Care of the Older Person LECTURE

a. Stochastic Theories Immunological Theory

the body’s inability to repair its systems aging is due to faulty
and delay the onset of aging is the immunological function which
result of minor changes that occur is linked to general well-
gradually on time based on random being
events that cause cellular damage that
accumulates as organism ages NURSING THEORIES OF AGING
Free Radical Theory Functional Consequences Theory
membranes, nucleic acids, focuses on the needs that are unique to
and proteins are damaged older individuals
by free radicals which Miller’s functional consequences theory
causes cellular injury and (2008) provides a frame for wellness
aging promotion in older adults by helping nurses
Orgel/Error Theory to recognize their potential for growth and
errors in DNA and RNA using wellness nursing diagnoses to foster a
synthesis occur with aging sense of value and dignity
Wear & Tear Theory it proposes that the ability of older adults to
cells wear out and cannot maintain maximal self care is affected by the
function with aging interaction of normal age-related changes
Connective Tissue/Cross-Link and additional risk factors the individual
Theory encounters
with aging proteins impede Theory of Thriving
metabolic processes and failure to thrive results from a discord
cause trouble with getting between the individual and his or her
nutrients to cells and environment or relationships. Nurses
removing cellular waste identify and modify factors that
products contributes to disharmony among these
b. Nonstochastic Theories elements
based on genetically programmed critical attributes of thriving are defined as
events caused by cellular damage that social connectedness, ability to find
accelerates aging of the organism environment, adaptation, adaptation to
Programmed Theory physical patterns, and positive
cells divide until they are no cognitive/affective function
longer able to; this triggers
apoptosis or cell death HEALTHY AGING AND LONGEVITY
Gene/Biological Clock Theory Healthy Aging
cells have a genetic is a continuous process of optimizing
programmed aging code opportunities to maintain and improve
Neuroendocrine Theory physical and mental health, independence,
problems with the and quality of life throughout the life course
Hypothalamus-Pituitary- Longevity
Endocrine Gland is the state in which years in good health
Feedback System causes approach the biological life span, with
disease; increased insulin physical, cognitive and social functioning,
growth factor increasing enabling well-being across populations;
aging maximization
 Care of the Older Person LECTURE

BIOLOGICAL ASPECTS OF AGING Cardiac muscles

vital organs begin to lose some function as we most of the heart wall
age (involuntary muscle)
changes occur in all of the body’s cells, tissues,
and organs, and these changes affect the
functioning of all body systems
Changes in the 4 basic types of tissue:
1. CONNECTIVE TISSUE
supports other tissues and binds them
together
this includes bones, blood, and lymph
tissues, as well as the tissues that give 4. NERVE TISSUE
support and structure to the skin and made up of nerve cells (neurons) and is used
internal organs to carry messages to and from various parts
2. EPITHELIAL TISSUE of the body
provides a covering for superficial and the brain, spinal cord, and peripheral nerves
deeper body layers are made of nervous tissue
the skin and the linings of the passages
inside the body, such as the gastrointestinal
system, are made of epithelial tissue

COMMON CHRONIC CONDITIONS

10 common chronic conditions for adults 65+
Hypertension 60%
High cholesterol 51%
Obesity 42%
Arthritis 35%
Ischemic/Coronary heart disease 29%
Diabetes 27%
Chronic kidney disease 25%
Heart failure 15%
Depression 16%
Alzheimer’s disease & Dementia 12%
Hypertension
when the pressure in the blood vessels is too
high (140/90 mmHg or higher)
3. MUSCLE TISSUE High Blood is common condition that affecs the
includes 3 types of tissue body’s arteries
Striated muscles Causes:
move the skeleton adrenal gland tumors
(voluntary muscle) blood vessel problems present at birth, also
Smooth muscles called congenital heart defects
muscles contained in the stomach cough and cold medicines, some pain
and other internal organs like the relievers, birth control pills, and other
female uterus prescription drugs
(involuntary muscle)
 Care of the Older Person LECTURE

illegal drugs, such as cocaine and Diabetes Mellitus

amphetamines happens when your blood sugar (glucose) is too
kidney disease high
obstructive sleep apnea it develops when your pancreas doesn’t make
thyroid problems enough INSULIN or any at all, or when your
Risk factors: body isn’t responding to the effects of insulin
age Causes
race insulin resistance
family history autoimmune disease
obesity or being overweight hormonal imbalances
lack of exercise
tobacco use or vaping
too much salt
low potassium levels
drinking too much alcohol
stress
certain chronic conditions
pregnancy
HYPERTENSION MANAGEMENT IN OLDER
AND FRAIL OLDER PATIENTS Type 2 Diabetes
1. aim for healthy weight people with T2D can live a healthy life
2. exercise most common types of diabetes
3. eat a heart-healthy diet DASH (dietary commonly seen in older adults, but increasingly
approaches to stop hypertension seen in children, adolescents, and younger
4. cut down on salt adults
5. drink less alcohol strong link with overweight and obesity
6. don’t smoke
7. get a good night’s sleep GERIATRIC SYNDROMES
8. manage stress include a number of conditions typical of, if not
specific to, aging such as dementia,
Arthritis depression, delirium, incontinence, vertigo,
redness and swelling of a joint falls, spontaneous bone fractures, failure to
osteoarthritis is the most common form of thrive, and neglect and abuse
arthritis among older adults
is a degenerative joint disease that happens
when the tissues that cushion the ends of the
bones within the joints break down over times
common signs include swelling, tenderness,
stiffness, and a crunching feeling or sound of
bone rubbing on bone
Management of arthritis in older person
1. medications
2. heat and cold
3. joint immobilization
4. massage
5. transcutaneous electrical nerve stimulation
(TENS)
6. acupuncture
 Care of the Older Person LECTURE

DEMENTIA Urinary Incontinence

a progressive deterioration in the intellectual involuntary loss of urine that is sufficient to be a
abilities in such a severity that it interferes with problem
the persons social and occupational the involuntary loss of urine so severe as to have
performance, the prevalence increases with social and/or hygienic consequences for
age individuals and/or their caregivers, is a major
is not specific disease but it rather a general clinical problem and a significant cause of
term for the impaired ability to remember, disability and dependency
think, or make decisions that interferes with
doing everyday activities
characterized by:
losses in memory, abstract reasoning
ability, judgment and language
personality changes
deterioration of the ability to perform ADLs
over time
symptoms are usually subtle in onset Consequences of IU
progressing slowly and eventually becoming cellulitis
obvious and devastating pressure ulcers
3 general categories urinary tract infection
cognitive falls with fractures
functional sleep deprivation
behavioral social withdrawal
reversible causes: depression
alcohol abuse embarassment
polypharmacy interference with activities
psychiatric disorders caregiver burden - contributes to
normal pressure hydrocephalus institutionalization
3 most common nonreversible dementias increase in healthcare cost
multi-infarct dementia decrease quality of life
alzheimer’s disease
mixed

Delirium
serious change in mental abilities
it results in confused thinking nd a lack of
awareness of someone’s surroundings
type of confusion that happens when the
combined strain of illnesses, environmental
circumstances or other risk factors disrupts your
brain function
more common in adults over 65 Fall in Older People
is a serious problem and can cause long-term around 1 in 3 adults over 65 and half of people
or permanent problems, especially with over 80 will have at least one fall a year
delays in treatment most falls do not result in serious injury. But
is an acute neuropsychiatric syndrome and there’s always a risk that a fall could lead to
one of the most common presenting symptoms broken bones, and it can cause the person to
of acute medical illnesses in older people lose confidence, become withdrawn, and feel
as if they have lost their independence
 Care of the Older Person LECTURE

learn how much to eat from all five food

groups and find out how many calories you
need each day to help maintain energy

Fall prevention
what are universal fall precautions?
familiarize the patient with the
environment
have the patient demonstrate call light Nutritional assessment
use inadequate micronutrient intake is common
maintain call light within reach in older persons
keep the patient’s personal possessions several age-related medical conditions may
within patient safe reach predispose patients to vitamin and mineral
have sturdy handrails in patient deficiencies
bathrooms, room, and hallway studies have shown that vitamins A, C, D,
Tinetti Balance and Gait Evaluation and B12; calcium; iron; zinc; and other trace
use for patients with parkinson disease or minerals are often deficient in the older
multiple sclerosis, traumatic brain injury, population, even in the absence of
and stroke patients conditions such as pernicious anemia or
using a standardized scoring system, the malabsorption
test assesses the patient’s balance and gait

NUTRITION AND HYDRATION IN OLDER

ADULTS
Geriatric Nutrition
Unique needs of people ages 60+
variety of foods from each group to help
reduce the
risk of developing chronic disease
choose foods with little to no added sugar,
saturated fats, and sodium
get enough protein during the day to
maintain muscle mass-increase of 50%
focus on the nutrients needed, including
potassium, calcium, vitamin D, dietary
fiber, and vitamin B12
with age, they may lose some of their sense
of thirst. DRINK OFTEN
Low-or fat-free milk, including lactose-
free options or fortifies soy beverage and
100% juice can also help them stay
hydrated
maintain a healthy weight or prevent
additional weight gain